Eating Thorns.   

In order to create their beautiful plumage peacocks sometimes eat thorns.   Hard pointed razor like objects are processed in their abdomens and then contribute to feathers with colors and shapes unmatched throughout nature for their extraordinary beauty.  So it is with us,  that which is the hardest to digest , to process , to integrate into our life experiences is what ultimately transforms us in a positive way.  We become who we are meant to be. 

Marianne Williamson.    Tears to triumph

This post is a bit political but it is really about how I feel about taking care of my patients, my family and my country. 

Inherently, I am a believer that we, in America should have a universal health care system.  If you have not been following my blog for very long, and you are  interested in learning more about why, refer to my blog from 11/2014.  It was a blog about  a book called the Healing of America by T.R. Reid.  You can see a summary of the research findings in that blog post.  

Since I moved from Maine to Colorado, my practice has been working our buts off on a quality project called CPCI. 

Led by the CMS Centers for Medicare and Medicaid Innovation (CMMI), the Comprehensive Primary Care initiative (CPC initiative) is a four-year, multi-payer initiative designed to test practice redesign models and a supportive multi-payer payment model.  The program grew beyond 4 years and we have just been chosen to complete the next chapter of that project.  It has been ALOT of work for all of my staff.  I am so grateful for the effort they were all willing to put in.  

My practice is a rural practice comprised of large numbers of medicare and medicaid patients.  With the affordable healthcare act, I have seen patients who have not had access to care for years .  Their only means was to seek care when they were in crisis which meant emergency room visits with a potential for needing expensive hospital care.  With the CPCI project, we have been able to study our population and to identify those who are in need of extensive management.  We have worked hard to see these patients frequently,  to educate them as to how to best manage their diseases.  We have taught them how to eat well, how to increase exercise, be more compliant with medications,  address the barriers that they have like poverty,  lack of support or transportation.   We have addressed their physical, emotional, mental and economic issues.  We have become a certified medical home and our patients are healthier.  We have significantly reduced emergency room visits, hospitalizations, readmissions to the hospital and unnecessary referrals to specialists.   We have also worked very hard to improve communication between the primary care physician and the specialists as patients transition between the two.  



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In early 2015, CMS released the first evaluation report(innovation.cms.gov)of the CPC initiative that reported favorable findings from the first program year (2013). CMS is pleased with the first year findings, but anticipates it will take 18 months to three years for practices to truly transform and to see efforts on cost, service use, and quality. Here’s what the first report has found:

• The CPC initiative reduced total monthly Medicare expenditures without care management fees during the first program year by $14 per beneficiary, or two percent.
• Impacts were large enough to offset most of CPC initiative’s monthly care management fees, which average $20 per patient per month among participating CPC practices. This implies that the CPC initiative as a whole was close to cost neutral during the first year.  An update to the evaluation report indicates the same reductions in cost through March 2014.
• More specifically, results show a reduction in high cost areas such as hospitalizations, emergency department visits, and specialist visits (all per 1,000 beneficiaries):
  • Annual Hospitalizations decreased by two percent.
  • Annual emergency department visits fell by three percent.
  • Annual specialist visits declined by two percent. 
  • Annual primary care visits in all settings fell by two percent.
  • There was a four percent CPC-wide decline (not quite statistically significant) in unplanned 30-day readmissions

We have just begun to understand from a primary care perspective, which is our foundation, how to reduce healthcare costs.  This was made possible under the affordable healthcare act.  It has not been perfect,  in a country such as ours it will take many years for the creation of a viable, sustainable health care system.  I do not believe the answer is in going back. I believe it is in continuing to build from what we currently have in place.  Having less people insured will only cost us money. I believe we all need to be insured.  

I worry about the repeal of the affordable healthcare for my own personal reasons as well.  Being a breast cancer survivor it could become very difficult for me to obtain health insurance.  Being the mother of a disabled son, I worry that he will lose the medicaid coverage that he has and his social security.  Being the mother of a son who has struggled with addiction, I worry that he will lose the mental health support  that he has gotten that has helped him to stabilize his addiction.  He now has a skill that makes him employable.  He is no longer in homeless shelters and he helps us to care for Lucas, my disabled son. Ignoring these kinds of issues does not make us a stronger country.   It does not save our healthcare system any money. 

I understand that I am powerless to really effect the outcome of what may pass with the coming week which would be in my opinion be sliding backwards to create an even sicker and more expensive health care issue, but i wanted to share the perspective of one passionate American family doctor and citizen.  There is no question in my mind that my patients are healthier today ( if they want to be) than they were when they were uninsured.  It greatly concerns me that the many of the people who bash Obama's healthcare plan really do not at all understand it.  They say things to me like " oh well i don't have Obamacare".  I say to them "Yes you do".    There really is a serious gap in understanding and I thought i would just share a little of my own perspective on this issue.

To end, on Martin Luther King Day

Our lives begin to end on the day that we become silent about things that matter..... Martin Luther King Jr